Chamber and committees

You keep saying that, but how are we going to fix it?

Thank you very much for that.

I am not talking down nurses.

Let us do a reality check. You agree with the First Minister that the NHS is “resilient” and “robust”, but not a single NHS board in Scotland is meeting its 12-week out-patient target or their in-patient target—not a single NHS board in Scotland is meeting its 18-week planned care target. One in six Scots is sitting on an NHS waiting list—that is nearly 900,000 people, of whom nearly 10,000 have been on a waiting list for over two years. To top it all off, Scotland has one of the lowest life expectancies in western Europe. Does that sound like a “resilient” and “robust” health service that is fit for purpose and that is delivering for the public?

The target for A and E treatment is that 95 per cent of people are dealt with within four hours. That can mean that someone is admitted to hospital, if that is considered necessary, then discharged, or treated then discharged. The current average performance is 69 per cent, which exactly marries up with what you have just said—far too many people in A and E are not being treated, moved on or moved out of that environment, which has a knock-on effect on ambulances.

What is the issue in A and E specifically? Are people turning up when they should not? Is it understaffed? What is the problem? What is causing the delay?

The figures are atrocious. I point you to page 48 of the Audit Scotland report, which I flagged at a previous meeting of the Public Audit Committee. What you would normally expect to see on that page—as I am pleased to see in other tables—are little green ticks where targets have been met. However, there is not a single green tick anywhere on that page.

The numbers speak for themselves. The targets are 95 per cent, 100 per cent and 90 per cent for beginning treatment within given timescales. They are ambitious. I get that. I know that the health service is very challenging across the UK, but look at the performance measures on that page. Look at in-patient treatment within 12 weeks of a decision to treat. The poor people in Grampian are sitting at 46 per cent of the 100 per cent target. Fife and Forth Valley are at 47 per cent. For the three targets, Lanarkshire is at 61 per cent, 46 per cent and 60 per cent—nowhere near the targets. There are huge numbers of people waiting for far longer than they should, and £100 million is not going to scratch the surface, is it?

It has already been mentioned, but one of the issues at the other end is delayed discharge. We have talked a lot about the flow of people going into hospital, but getting them out is key. However, I am afraid that the statistics on that are equally atrocious. In 2023, 658,000 bed days were taken up by delayed discharge. Those are days on which beds could have been occupied by all those people who were sitting in A and E waiting to be admitted. We do not have the full statistics yet for 2024, but doing a year-on-year analysis from November to November, there was a 7 per cent increase in delayed discharge days. My fear is that the number for 2024 will not be great, either.

Of course, the Government promised to eliminate delayed discharge completely, but I do not know how on earth it thought that it was going to do that. It was an admirable ambition, but it is clearly not happening. We had a conversation earlier in which you admitted to being the accountable officer for NHS health and social care, but many of the levers that are required to deal with delayed discharge are entirely outside your control. It must be a huge source of frustration that you cannot really fix that problem, can you?

That is a whole other committee session, is it not?

Given the huge pressures that public finance is under—we have spent two hours talking about them—are you comfortable about the fact that there are civil servants working for you on theoretical white papers—13, I believe, in total? Does that sound like good use of civil service time and taxpayers’ money to you?

Ms Stafford, does anyone in the Scottish Government advise ministers on their taxation policy? Does anyone, at any point, undertake an analysis of the revenues that are achieved versus what was expected? How are we faring with that? Is the Government, through variation in taxation bands in Scotland, getting the amount of money in tax that it thought that it would? Are we looking only at tax intake, or are we looking at the bigger picture in terms of wider investment, difficulty in recruiting and all the other economic factors that sit around taxation policy, not just the numbers themselves?

Many people have lauded and applauded the decisions that have been made, and others, particularly in the business community, have criticised those decisions. I am trying to unearth how the civil service goes about advising ministers on the right course of action, or, indeed, how it flags up any areas of taxation that it thinks should perhaps be changed in the future.